HomeMy WebLinkAboutSWG2021-00532 - SWG As-Built - 1/16/2024 4.
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG 2021-00532 Parcel# 22105-52-00046
Applicant Name Joe Snyder Subdivision (Name/Div/Block/Lot)
Applicant Address 822-24th Ave NW
City, State, Zip Gig Harbor,Wa 98335 Installer Name Bayshore Construction
Site Address 2870 Mason Lake Dr.W. Designer Name Bob Paysse
INSTALLATION CHECKLIST
® Full System Installation ❑Tank(s)Only 0 Drainfield Only ❑Repair ❑Other
System Type Pretreatment to pressure Pretreatment Type Nu Water BNR 500
>5 ft.from foundation? - •- 0 N/A 111111 YES ❑ NO
>50 ft.from wells? - - 0 11 0
Y >50 ft. from surface water? - - 0 ® ❑
Z
H Cleanout between building and tank? - - ❑ NI El
U Tank baffles present? - - 0 ® 0
d24"access risers over each compartment?- - El ® 0
W Effluent filter installed?- - II 0 0
Septic tank capacity(working) 1200 gal Manufacturer Evergreen Precast
0 D-box water level and speed levelers used? - - N/A ❑YES 0 NO
O Manifold/D-box accessible from surface?- - 0 ® ❑
iv Check valves installed? - - 0 ® 0
ctQ
2 Transport Line Size 2" Schedule/Class 40
Bedrooms installed (check one) ❑ 2 0 3 ®4 0 5 ❑6 0 Commercial/Other
>10 ft.from foundation?- - 0 NIA ®YES 0 NO
O >100 ft.from wells?- - II 0 0
W >100 ft.from surface water? - - 0 MI El
u. >10 ft.from potable water lines?- - 0 ® 0
Ed. > 5 ft.from property lines and easements?- - ® ,- 0 0
d > 30 ft.from downgradient curtain/foundation drains?- - ® 0 0
• Drainfield level and observation ports present - - ❑ IN 0
0 Graveless chambers or 111 Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 II 0
Pump tank setbacks consistent with septic tank? - - ❑ NIA U YES ❑ NO
• Pump tank capacity(flood) 1500 gal Manufacturer
Z
H24"access riser(s)and accessible from surface?- - El III Eld Alarm or Control Panel Installed? - - 0 IR 0
Control Panel equipped with Timer/ETM I Counter- - 0 ® 0
d Pump installed in NI Bucket or 0 On Block or ❑ Other Evergreen Precast
a'• Pump Make/Model Liberty 290 MI Floats or 0 Transducer
p_ Tank draw down in/min Pump capacity gpm Squirt Height 48"+ ft
a
Pump on time TBD Pump off time Daily flow set at 480 gpd
' Updated 841,2018
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Mason County OSS Installation Report pg. 2 Parcel# 22105-52-00046
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - ® YES 0 NO
If yes, please describe:existing tank pumped and filled in w/sand
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ® YES 0 NO
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to relocate In the need of maintenance activities and future development Typical Record
Drawings contain- Dra ntieid&manifold orientation&layout,Septicfpcmp lark loca:brr.North arrow.reserve drainfield.existing and proposed buildings.location of wells.waterlines.
wells observat on ports.coanouts.and other maintenance access points. Incomplete Record Draw.r:ys may create addition&delays•n 51a Instnll.itIOn approval and related permits.
II Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance with the septic design stamped"APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes, State and Mason County Codes
l further certify that all i rmation contained on this I further certify that all information contained on this
form and,tta ed cord Drawing is accurate. form and attached Record Drawing is accurate.
(
1 1
7/18/22 s.
Signature of Installer Date t �
Brandon Thompson „tylk.-..,..
Printed Name of Signee 9/ 1—C--
MASON COUNTY PUBLIC HEALTH `.1,, ''�
1.. S1Bmf/ +..
The undersigned approves this Installation Report and ecl ROBERT H PAYSSE :• `
Record Drawing on behalf of Mason County Public ,/! a
EXPIRES
Health:
,(M1 V / i
Signature of Environmtintal Health Specialist Date (stamp,signature and date)
Updated 82t.2
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE 16
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